Womb: The Inside Story of Where We All Began by Leah Hazard
Back in 2019, I reviewed Hard Pushed, Leah Hazard’s memoir of being a midwife in a busy Glasgow hospital. Here she widens the view to create a wide-ranging and accessible study of the uterus. As magisterial in its field as Siddhartha Mukherjee’s The Emperor of All Maladies was for cancer, it might have shared that book’s ‘A Biography’ subtitle and casts a feminist eye over history and future alike. Blending medical knowledge and cultural commentary, it cannot fail to have both personal and political significance for readers of any gender.
The thematic structure of the chapters also functions as a roughly chronological tour of how life with a uterus might proceed: menstruation, conception, pregnancy, labour, caesarean section, ongoing health issues, menopause. With much of Hazard’s research taking place at the height of the pandemic, she had to conduct many of her interviews online. She consults mostly female experts and patients, meeting people with surprisingly different opinions. For instance, she encounters opposing views on menstruation from American professors: one who believes it is now optional, a handicap – for teenagers, especially – and that the body was never meant to endure 350–400 periods compared to the historical average of 100 (based on shorter lifespan plus more frequent pregnancy and breastfeeding); versus another who is concerned about the cognitive effects of constant hormonal intervention.

The book forcefully conveys how gynaecological wellness is threatened by a lack of knowledge, sexist stereotypes, and devaluation of certain wombs. Even today, little is known about the placenta, she reports, so research involves creating organoids from stem cells that act like it would. The use of emotionally damaging language like “irritable/hostile uterus,” “incompetent cervix” and “too posh to push” is a major problem. The sobering chapter on “Reprocide” elaborates on enduring threats to reproductive freedom, such as non-consensual sterilization of women in detention centres and the revoking of abortion rights. And even routine problems like endometriosis and fibroids disproportionately affect women of colour.
Hazard has taken pains to adopt an inclusive perspective, referring to “menstruators” or “people with a uterus” as often as to women and mentioning health concerns specific to transgender people. She is also careful to depict the sheer variety of experience: age at first menses, subjective reactions to labour or hysterectomy, severity of menopause symptoms, and so on. Where events have potentially traumatic effects, she presents alternatives, such as a “gentle” or “natural” Caesarean, which is less clinical and more empowering. The prose is pitched at a good level for laypeople: conversational, and never bombarding with information. That I have not had children myself was no obstruction to my enjoyment of the book. It is full of fascinating content that is relevant to all (as in the Harry and Chris solidarity-themed song “Womb with a View,” which has the repeated line “we’ve all been in a womb”). 
Here are just some of the mind-blowing facts I learned:
- Infant girls bleed in what as known as pseudomenses.
- Research is underway to regularly test menstrual effluent for endometriosis, etc. and the uterine microbiome for signs of cancer.
- The cervix can store sperm and release it later for optimal fertilization.
- Caesarean section and induction with oxytocin now occur in one-third of pregnancies, despite the WHO recommendation of no more than 10% for the former and the danger of postpartum haemorrhage with the latter.
- After childbirth, a discharge called lochia continues for 4–6 weeks.
- There have been successful uterine transplants from living donors and cadavers.
- Artificial wombs (“biobags”) have been used for other mammals and are in development; Hazard cautions about possible misogynistic exploitation.
With thanks to Virago Press for the free copy for review.
Hard Pushed: A Midwife’s Story by Leah Hazard
“For fans of Adam Kay’s This Is Going to Hurt and Christie Watson’s The Language of Kindness,” the blurb on my press release for Leah Hazard’s memoir opens. The publisher’s comparisons couldn’t be more perfect: Hard Pushed has the gynecological detail and edgy sense of humor of Kay’s book (“Another night, another vagina” is its first line, and the author has been known to introduce herself with “Midwife Hazard, at your cervix!”), and matches Watson’s with its empathetic picture of patients’ plights and medical professionals’ burnout.
Hazard alternates between anonymized case studies of patients she has treated and general thoughts on her chosen career (e.g. “Notes on Triage” and “Notes on Being from Somewhere Else”). Although all of the patients in her book are fictional composites, their circumstances are rendered so vividly that you quickly forget these particular characters never existed. Visceral details of sights, smells and feelings put you right there in the delivery room with Eleanor, one-half of a lesbian couple welcoming a child thanks to the now-everyday wonder of IVF; Hawa, a Somali woman whose pregnancy is complicated by the genital mutilation she underwent as a child; and Pei Hsuan, a Chinese teenager who was trafficked into sex work in Britain.
Sometimes we don’t learn the endings to these stories. Will 15-year-old Crystal have a healthy baby after she starts leaking fluid at 23 weeks? What will happen next for Pei Hsuan after her case is passed on to refugee services? Hazard deliberately leaves things uncertain to reflect the partial knowledge a hospital midwife often has of her patients: they’re taken off to surgery or discharged, and when they eventually come back to deliver someone else may be on duty. All she can do is to help each woman the best she can in the moment.
A number of these cases allow the author to comment on the range of modern opinions about pregnancy and childrearing, including some controversies. A pushy new grandmother tries to pressure her daughter into breastfeeding; a woman struggles with her mental health while on maternity leave; a rape victim is too far along to have a termination. At the other end of the spectrum, we meet a hippie couple in a birthing pool who prefer to speak of “surges” rather than contractions. Hazard rightly contends that it’s not her place to cast judgment on any of her patients’ decisions; her job is simply to deal with the situation at hand.
I especially liked reading about the habits that keep the author going through long overnight shifts, such as breaking the time up into 15-minute increments, each with its own assigned task. The excerpts from her official notes – in italics and full of shorthand and jargon – are a neat window into the science and reality of a midwife’s work, with a glossary at the end of the book ensuring that nothing is too technical for laypeople.
Hazard, an American, lives in Scotland and has a Glaswegian husband and two daughters. Her experience of being an NHS midwife has not always been ideal; there were even moments when she was ready to quit. Like Kay and Watson, she has found that the medical field can be unforgiving what with low pay, little recognition and hardly any time to wolf down your dinner during a break, let alone reflect on the life-and-death situations you’ve been a part of. Yet its rewards outweigh the downsides.
Hard Pushed has none of the sentimentality of Call the Midwife – a relief since I’m not one to gush over babies. Still, it’s a heartfelt read as well as a vivid and pacey one, and it’s alternately funny and sobering. If you like books that follow doctors and nurses down hospital hallways, you’ll love it. This was one of my most anticipated books of the first half of the year, and it lived up to my expectations. It’s also one of my top contenders for the 2020 Wellcome Book Prize so far.
A few favorite passages:
“So many things in midwifery are ‘wee’ [in Scotland, at least!] – a wee cut, a wee tear, a wee bleed, the latter used to describe anything from a trickle to a torrent. Euphemisms are one of our many small mercies: we learn early on to downplay and dissemble. The brutality of birth is often self-evident; there is little need to elaborate.”
“Whenever I dress a wound in this way, I remember that this is an act of loving validation; every wound tells a story, and every dressing is an acknowledgement of that story – the midwife’s way of saying, I hear you, and I believe you.”
“midwives do so much more than catch babies. We devise and implement plans of care; we connect, console, empathise and cheerlead; we prescribe; we do minor surgery. … We may never have met you until the day we ride into battle for you and your baby; … you may not even recognise the cavalry that’s been at your back until the drapes are down and the blood has dried beneath your feet.”
My rating: 
Hard Pushed was published in the UK on May 2nd (just a few days before International Midwives’ Day) by Hutchinson. My thanks to the publisher for the free proof copy for review.























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